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Impact of thrombus aspiration in frail STEMI patients

Pasquale Mone1,2, Jessica Gambardella3,4, Antonella Pansini5

  • 1University of Campania "Vanvitelli", Piazza Miraglia, Naples, Italy. pasquale.mone@unicampania.it.

Aging Clinical and Experimental Research
|April 5, 2021
PubMed

Insights

Thrombus aspiration (TA) before primary percutaneous coronary intervention (PPCI) significantly reduced mortality and re-hospitalizations in elderly patients with ST-segment elevation myocardial infarction (STEMI). This approach offers a vital improvement for frail individuals undergoing PPCI.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Geriatric Medicine

Background:

  • Primary percutaneous coronary intervention (PPCI) is standard care for ST-segment elevation myocardial infarction (STEMI) in older adults.
  • Frail elderly patients with STEMI experience high rates of re-hospitalization despite PPCI.

Purpose of the Study:

  • To investigate if thrombus aspiration (TA) prior to PPCI can decrease mortality and re-hospitalization rates in frail STEMI patients.
  • To evaluate the efficacy of TA + PPCI versus PPCI alone in this high-risk population.

Main Methods:

  • A comparative study of 389 frail patients (≥65 years) with first STEMI treated between 2008-2015.
  • Patients received either PPCI alone or TA followed by PPCI.
  • Outcomes assessed included all-cause mortality, cardiovascular mortality, and re-hospitalization rates at 1-month follow-up.

Main Results:

  • TA + PPCI group showed significantly lower all-cause mortality (3.0% vs 7.0%) and cardiovascular mortality (3.0% vs 6.0%) compared to PPCI alone.
  • Re-hospitalization rates for heart failure (4.0% vs 7.5%) and acute coronary syndrome (4.5% vs 10.0%) were also significantly reduced with TA + PPCI.
  • The observed differences were statistically significant (p < 0.05 for all).

Conclusions:

  • Thrombus aspiration is an important adjunctive therapy for STEMI treatment in elderly, frail patients.
  • This strategy improves clinical outcomes by reducing mortality and re-hospitalizations.
  • TA + PPCI represents a valuable approach for managing high-risk STEMI patients.
Abstract

Keywords:
FrailtySTEMIThrombus aspiration

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